Breast Reconstruction is performed to recreate a breast that has been removed during mastectomy. The extent of the breast reconstruction procedure depends on what changes are desired and what you and Dr. Sproule deem appropriate. The operation is performed in the hospital under general anesthesia.
There are various surgical approaches to breast reconstruction. The technique employed will differ according to the type of mastectomy performed and the condition of the breast skin.
When the remaining breast skin is loose and of adequate thickness, breast reconstruction may be accomplished solely by means of a surgical implant or prosthesis. To insert the prosthesis, Dr Sproule will usually make an incision where the lower portion of the breast would normally be. Working through the incision, a pocket is created beneath the skin and remaining muscle. In the pocket, the breast prosthesis is placed, a thin, flexible plastic envelope containing silicone gel, saline solution or a combination of both. A few sutures close the incision.
When the skin of the chest following a mastectomy is too tight to accommodate the implant, additional skin must be brought into the area in the form of a flap which consists of skin, muscle and the blood vessels that sustain them. Frequently, the broad muscle in the back, the latissimus dorsi, and its overlying skin is used as donor tissue. In this procedure, the flap is detached and tunnelled underneath the skin to the chest. It is sutured to local skin to form a pocket for the prosthesis. Together the flap and prosthesis create the breast mound. Sutures close the incisions in the back, leaving behind a scar.
Another breast reconstruction technique uses a flap from the abdomen consisting of part of the rectus abdominus muscle and its overlying skin. Incisions are made in the abdomen to form the flap which is then tunnelled to the breast area. When the flap is folded in on itself, it may create a large enough mound to preclude a breast implant. If additional fullness is desired, a prosthesis may also be used. The donor site is closed by sutures, leaving a flatter stomach and a low scar. In some patients, Dr. Sproule may employ yet another breast reconstruction technique. A balloon-like device called a skin or tissue expander is placed beneath the chest muscle and gradually filled with a saline solution over several weeks. The stretched skin may allow implantations of a prosthesis to create a more generous breast mound.
Depending on the reconstructive technique and whether breast reconstruction surgery is performed on the opposite breast at the same time, the operation can last from two to seven hours. Following surgery, restrictive bandages are placed over the breast.
When a later operation to reconstruct the nipple and areola is desired, skin grafts are generally used and combinations of local tissue from other parts of the body, most commonly the upper inner thigh and lips of the vagina.
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